.png)
13 hours ago
4
In 1988, 712 people lived at the Hebrew Rehabilitation Center for the Aged, a Boston nursing home affectionately named “Hebrew rehab” by its residents and staff. The residents’ average age was 88, and three-quarters of them were women. Every resident had multiple medical conditions. Almost half required help to engage in the essential activities of daily life: getting out of bed, going to the bathroom, bathing, walking, eating. But they were survivors. Some had survived the Holocaust. Others fled the Cossacks. They all lived through the Great Depression.
They were ideal research subjects for Maria Fiatarone, a young doctor and faculty member in geriatric medicine at both Tufts and Harvard. In terrible shape, with lifetimes of practice overcoming great challenges: to Fiatarone, they were perfect.
Beginning in the late 1980s, Fiatarone ran a series of studies in which she asked residents to commit to a regimen of high-intensity strength training. To many of her colleagues, the research seemed risky. Conventional wisdom in medicine at that time said the oldest people were not capable of lifting heavy weights – it might cause cardiac events. In all of western medical literature, Fiatarone found no evidence that any doctor had ever previously tried to teach frail 90-year-olds to do this kind of training.
But she pressed forward with the research, and the Hebrew rehab lifters produced unprecedented proof that high-intensity progressive resistance training can strengthen and build muscle even for the oldest people, with life-changing effects. Hebrew rehab residents who lifted weights gained power to function more independently, and to live with more autonomy and dignity, into their last years.
Of the 10 residents Fiatarone chose for the first study – six women and four men – eight had a history of falls. Seven used canes or walkers to get around. Most were on at least four medications. Most had at least four chronic diseases. The most common diseases in this group were osteoarthritis, coronary artery disease, hypertension and osteoporosis.
Their workout program would be simple. It would consist of one exercise. The exercise was the knee extension. Picture someone sitting on the edge of a straight-backed chair. She contracts her quadriceps to extend her knees, lifting her lower legs. At the top of the motion, both legs extend straight out from her lap. Then she bends her knees to lower her shins and feet back down. The lift comprising that whole movement, up and down, is called the knee extension.
Two things make the knee extension a good exercise for 90-year-olds. You can do it sitting down, and it strengthens muscles that help you stand up.
To begin the study, Fiatarone and colleagues conducted maximal strength tests, determining the heaviest weight each person was able to lift one time with perfect form and through a full range of motion – their “one-repetition maximum”, or 1-RM. On average, the 10 maxed out at lifting less than 20lb. One person lifted almost 40. One person lifted about five.
Each of the 10 residents then started coming to the physiotherapy room for three strength training sessions per week. In the first week, they lifted weights equal to 50% of their 1-RM, and for the rest of the two-month program, they lifted 80% of 1-RM. Their muscles adapted quickly, so the 1-RM tests were repeated every other week, to keep their efforts at 80% of maximum, allowing for consistent progress in their training to get stronger.
One month into the two-month program, an 86-year-old man dropped out – an old hernia repair was bothering him – and then there were nine. In each training session, the lifters completed three sets of eight repetitions. They raised and lowered the weights very slowly: three or four seconds up, three or four seconds down. Between each of the three sets, they rested for a minute or two.
There were no cardiovascular complications among the nine. They lifted and lowered the weight so slowly that their blood pressure and pulse rates (which were continuously monitored) barely changed. Four of the nine occasionally reported some discomfort in the hips or knees, but not to the point where anyone had to take a pain reliever or miss a training session. Everyone was able to do what was asked of them. And everyone did it. The study’s attendance rate was 98.8%.
These people were dedicated, and they got stronger. The smallest strength gain was 61%. The largest was 374%. The average gain was 174%. The average increase in walking speed as measured by tandem gait was almost 50%. The magnitude of improvements for men and women were the same. Their muscles had not only grown stronger, but also bigger. In 1990, the Journal of the American Medical Association published results of Fiatarone’s study, a paper now widely considered to mark the start of a paradigm shift in scientific understanding of muscle, strength and ageing. The 90-year-olds’ muscles grew by almost the same amount that a younger person’s muscles would grow in response to a similar lifting program.
When Fiatarone began her research, she confronted skepticism and prejudice, stemming from ambivalence about muscle and weight training that was baked into medicine and mainstream popular culture. Even as she first proved that progressive resistance exercise is critical to long-term health for all, weight training was widely scorned, slighted and dismissed as hedonistic and extreme – because it was linked in that era’s headline news with steroid scandals, a newly reported psychiatric disorder among bodybuilders that would eventually be named “muscle dysmorphia”, and Saturday Night Live’s Hans and Franz.
Fiatarone was not distracted or deterred. Her studies of weight training, built upon and inspired by others’ research on younger subjects, helped establish a new perspective on their subject: for young and old alike, muscle-strengthening exercises can be a locus of regeneration, offering chances for growth and development; for service and self-improvement; and for healing and renewal.
From birth, through the typical course of growth, most people build muscle up to a peak at the age of 30 or so. Then comes decline, when people lose muscle at a rate of at least 3-5% per decade.
By the time we are older, in our 60s and 70s, the rate of loss can accelerate to roughly 1% a year, or 10% a decade. General physical activity does not prevent age-related loss of muscle, but with progressive resistance training, the losses can be slowed, or even substantially reversed.
Even in the short time of Fiatarone’s eight-week study at Hebrew rehab, when older people’s muscles changed, their lives changed.
Dorothy Tishler was 92. In her first session she lifted 17lbs with each leg. Eight weeks later, her strength had more than tripled. She lifted 60lbs with each leg. “I love it,” she told the reporter from the Jewish Advocate who visited the gym. “I have become younger. When I came here five years ago, I could hardly walk. Now I walk better than my daughter, who’s only 72.”
after newsletter promotion
Strength training is safe – this was the most important truth established by the Hebrew rehab study. In structured regimens overseen by qualified trainers, high-intensity strength training involves very low risk, even for the frailest, oldest people. As Fiatarone wrote, edging as near sarcasm as the idiom of medical literature allows: “The known hazards of immobility and falls seem to outweigh the potential risks of muscle strengthening interventions in this population.”
Since then, research has consistently shown that resistance training injuries are rare, especially when people follow planned exercise programs under expert supervision; and this is true for people of all ages, at all levels of ability.
The Hebrew rehab lifters showed that strength training can be not only safe for practically everyone but also feasible: easy and convenient. Fiatarone would later say: “To me, it was always the idea to keep exercise simple, keep focused on what was the most feasible thing to do.” Strength training is feasible in nursing homes, she says, whereas aerobic training may not be. To some, that may sound counterintuitive, but it’s the commonsense conclusion of her experience working with the oldest people. She continues: “When you go to a nursing home, it’s quite clear that people can’t do lots of kinds of aerobic exercise. Simple walking is really hard. Yet people can sit at a machine and lift heavy weights. It’s very much the opposite of what people think.”
The Hebrew rehab strength-training study had extensive practical implications. Its philosophical implications were at least as far-reaching. What happened at Hebrew rehab upended the traditional story of ageing. The cliché of inevitable decline – as age increases, function wanes – turned out to be false. What happened in Dorothy Tishler’s legs suggested nothing less than a new way of considering the course of human life. The cliche that it’s never too late turned out to be true. Even into oldest age, even in dire situations, every person has some power to change how time changes the body. Especially if you have help, and knowledge.
Still, the Hebrew rehab lifters had not conquered time. Their example offered hope to others, but demanding hope. “All subjects resumed their sedentary lifestyle” after the study ended, Fiatarone found in follow-up visits with them. They resumed their sedentary lifestyle because the nursing home had no system or program in place to help them continue training. One month after the nine stopped lifting, they had lost, on average, a third of what they had gained during three months of workouts.
“Changes in muscle function are not maintained in the absence of continued training,” Fiatarone wrote in the published study. Ongoing improvement would require “an ongoing program of muscle reconditioning”.
Changes in muscle are not maintained for long periods of time, in the absence of continued training – for anyone, of any age. Up to the age of 35 or so, most younger people are, however, able to maintain muscular strength and mass with minimal frequency of exercise – as little as one workout per week, involving as little as one set per exercise. Likewise, most older people who have gotten stronger at the gym can maintain their increased ability to exert force with the same modest number of workouts, just one per week. Maintaining muscle mass for older people seems to require more exercise, though – at least two workouts per week, involving at least two or three sets per exercise.
By 1992, four years after the first small group of residents at the Hebrew Rehabilitation Center began lifting weights, workouts had become a fixture of the culture of this nursing home. About half the residents had adopted some kind of strength training regimen by the late 1990s.
An article in the Jewish Advocate in 1999 marked 1o years since the newspaper covered Fiatarone’s first strength training study.
“Is the program merely the outgrowth of a perverse and impossible forever-young culture,” asked an intrepid reporter, “or is there meaning behind the madness? What is it?”
“It’s a godsend, that’s what it is,” Ben Engleman said. He was 93 years old. He had been a shoe salesman in Swampscott, Massachusetts. When he arrived at the nursing home, he could not comb his hair or tie his tie. Four years later, because he followed a strength-training regimen, he was able to make himself look sharp again, without needing a hand from anyone else.
Maria Fiatarone’s discoveries that older people could build muscle, strength and functional abilities by lifting heavy weights were reproduced by many other researchers around the world. Nevertheless, in most of the medical profession, as in global popular culture, ignorance about older people’s potential to build muscle and strength persists, as part of a general failure to recognize the centrality of muscle in human life and health for everyone, throughout the lifespan.
-
This is an adapted excerpt from Stronger: The Untold Story of Muscle in Our Lives by Michael Joseph Gross, a longtime Vanity Fair contributing editor. The book is being published this week by Dutton and by Weidenfeld & Nicolson
